Secondary reanimation procedures in late obstetrical brachial plexus palsy patients

Abstract

The varying degrees of spontaneous reinnervation that occur in untreated obstetrical brachial plexus palsy leave characteristic deformities of the shoulder, elbow, forearm, wrist, and hand. Common sequelae are internal rotation and adduction deformity of the shoulder, elbow flexion contractures, forearm supination deformity, and lack of wrist extension and finger flexion. Early microsurgical reconstruction of the affected plexus leads to a more rewarding overall function of the upper arm, but residual deformities might appear later which are similar, although less serious, than those observed in untreated cases. Secondary procedures of the shoulder, elbow, forearm, and hand will improve the appearance and function of the upper extremity in late cases of obstetrical brachial plexus. Careful preoperative planning is mandatory and a multistage approach should be applied, depending on the type of palsy and the age of the patient.

Documentation of postoperative pain in the neonatal brachial plexus palsy population

“…As children with NBPP mature, some will develop internal rotation contractures at the shoulder, a secondary sequela to the initial birth injury (Sever 1918, Zancolli 1981, Pearl 2003, Pearl et al. 2006, Soucacos et al. 2006).…”

“…The contracture causes weak external rotation, which is often surgically modified through a procedure such as a RO (Zancolli 1981, Pearl et al. 2006, Soucacos et al. 2006) and/or R&T procedure (Sever 1918, Zancolli 1981, Pearl 2003, Soucacos et al.…”

“…2006, Soucacos et al. 2006) and/or R&T procedure (Sever 1918, Zancolli 1981, Pearl 2003, Soucacos et al. 2006, Mehlman & Koepplinger 2007).…”

“…2006, Mehlman & Koepplinger 2007). RO candidates have tight internal rotator muscle(s), which are surgically released to allow a weak infraspinatus muscle to move the arm into external rotation (Zancolli 1981, Soucacos et al. 2006, Mehlman & Koepplinger 2007).…”

Wrist Arthrodesis for Brachial Plexus Palsy Using an External Fixator and a Cannulated Screw (Ioannina Technique)

“…After nerve reconstruction, upper-limb function can be improved by secondary operations, including osteotomies, muscle transpositions, free functional muscle transfers, and arthrodeses. 1,2 In global brachial plexus injuries where the wrist and hand are paralysed, wrist arthrodesis may enhance hand function. In cases where the hand has some function, wrist arthrodesis may stabilise the joint and provide motor units for tendon transfers (i.e.…”